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General NPI Number Information
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NPI Number | 1700019304
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Entity Type | Organization
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Legal Business Name | O & P INNOVATIONS
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Dates
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Enumeration Date | 08/29/2009
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Last Update Date | 08/29/2009
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Provider Practice Location Address
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Address Line | 330 FOREST DR
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7351
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Country | US
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Telephone | 847-754-7434
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Fax |
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Provider Business Mailing Address
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Address Line | 330 FOREST DR
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7351
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | PATRICK FLANAGAN
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Credential | CO FAAOP
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Telephone | 847-754-7434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 213-000023
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License Number State | IL
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